Regulation 45: Review of Quality of Care : Six-Monthly Quality Review, Children's Outcomes, Consultation, Analysis & Continuous Improvement

The current position

Regulation 45 of the Children's Homes (England) Regulations 2015 requires the registered person to complete a review of the quality of care provided for children at least once every six months. But Regulation 45 is more than a six-monthly review. It also requires the registered person to establish and maintain an ongoing system for monitoring, reviewing and evaluating the quality of care, children's feedback and opinions, and the actions needed to improve or maintain quality. After completing the review, the registered person must produce a written report and supply it to HMCI within 28 days. The review is the provider's own quality assurance duty. It is not an independent scrutiny function like Regulation 44.

The review and the report are not the same thing

The most common mistake is treating Regulation 45 as a report-writing exercise. The regulation requires a review of the quality of care. The report is the output of the review. If the review has not genuinely examined evidence and consulted people, the report is just paperwork.

A good Regulation 45 review asks: what is the experience of children in this home? What is getting better? What is not? What should we change? The report records the answers and the actions that follow.

What Regulation 45 requires

Regulation 45 contains several distinct duties. Regulation 45(1) requires the registered person to complete a review of the quality of care provided for children at least once every six months. Regulation 45(2) requires the registered person to establish and maintain an ongoing system for monitoring, reviewing and evaluating the quality of care, children's feedback and opinions, and actions necessary to improve or maintain quality. Regulation 45(3) requires the registered person to produce a written report about the review and the actions they intend to take. Regulation 45(4) requires the registered person to supply HMCI with a copy of the report within 28 days of completing the review, and to make a copy available on request to a placing authority in specified circumstances. Regulation 45(5) requires the system to provide for ascertaining and considering the opinions of children, their parents, placing authorities and staff.

Who is responsible

The legal Regulation 45 duty sits with the registered person. A Registered Manager, Responsible Individual, quality lead or other staff may contribute operationally to the review, but this does not transfer the statutory duty. Current Ofsted policy expressly states that Ofsted does not register the Responsible Individual. The registered person remains responsible for the review and the report.

Can a quality lead help?

Yes. A quality or compliance lead can support the review, gather evidence and draft the report. But the statutory duty remains with the registered person. Others may support the process, but the registered person must own the review and the report. A quality lead who does the review without the registered person's engagement is not the same as the registered person reviewing the quality of care.

The ongoing monitoring system

Regulation 45 does not simply require someone to sit down every six months and write a retrospective report. Regulation 45(2) requires the registered person to establish and maintain an ongoing system for monitoring, reviewing and evaluating the quality of care, children's feedback and opinions, and the actions needed to improve or maintain quality. The six-monthly review under Regulation 45(1) draws on this ongoing system.

It helps to distinguish three layers. The ongoing system (Regulation 45(2)) is the continuous monitoring, reviewing and evaluation of the quality of care and children's feedback. The formal review (Regulation 45(1)) is the completed review of the quality of care at least every six months. The written report (Regulation 45(3)) is the output produced after completing the review. A home that only thinks about quality of care in the fortnight before a report is due is not maintaining the system Regulation 45(2) requires.

Frequency and the 28-day rule

Regulation 45(1) requires the review to be completed at least once every six months. Current Ofsted guidance confirms providers may choose dates that work for the home as long as the statutory six-month frequency is met. CHH good practice: the six-month periods should be clear and consistent. A review that drifts, or where the six-month gap is stretched, is not meeting the regulation.

Regulation 45(4)(a) requires the registered person to supply HMCI with a copy of the report within 28 days of the date the review was completed. This is a statutory deadline. The review must be completed, the written report produced, and the HMCI copy supplied within 28 days of completion. CHH good practice: the report should follow promptly after the review. A review conducted in March with a report not written until June is not a timely quality assurance cycle.

Report distribution and the 28-day deadline

Regulation 45(4)(a) requires the registered person to supply HMCI with a copy of the report within 28 days of the date the review was completed. This is a statutory deadline set out in the Regulation itself. It is different from the Regulation 44 operational deadline, which is an Ofsted operational position requiring the Reg 44 report to reach Ofsted before the end of the month following the visit month.

Regulation 45(4)(b) requires the registered person to make a copy of the report available on request to a placing authority in the circumstances specified by the Regulation. The Regulation does not require automatic statutory distribution to every parent, every staff member, every placing authority, or the Responsible Individual. If statutory guidance recommends wider distribution, that is separate from the Regulation 45(4) statutory requirement.

What the review should focus on

The review should focus on the quality of care and the experience of children. It is not an audit of every Quality Standard every six months. The regulations do not require that. The review should look at what matters for this home at this time.

CHH practical guidance: a good approach is to have core areas that are always reviewed, plus rotating areas that are looked at in depth on a cycle. Safeguarding should always be in the core. Other areas can rotate based on what is happening in the home, what has changed, and what previous reviews identified. The regulations do not prescribe a rotating programme.

Two homes should not necessarily have identical Regulation 45 reviews. A home that has had a serious incident may need to focus on safeguarding and restraint. A home that has had high staff turnover may need to focus on staffing and induction. The review should be tailored to the home's circumstances.

Consulting children, parents, placing authorities and staff

Regulation 45(5) requires the system under Regulation 45(2) to provide for ascertaining and considering the opinions of children, their parents, placing authorities and staff. This is a legal requirement on the system. Current Ofsted guidance expects Regulation 45 reviews and reports to include the opinions of children, parents, placing authorities and staff. Distinguish the legal requirement (the system must provide for ascertaining and considering opinions) from the Ofsted expectation (the review and report should contain those opinions).

Children's views

Children's feedback and opinions have two distinct places in Regulation 45. Regulation 45(2)(b) specifically requires the ongoing system to monitor, review and evaluate the feedback and opinions of children about the home, its facilities and the quality of care they receive. Regulation 45(5) separately requires the system to provide for ascertaining and considering the opinions of children (alongside parents, placing authorities and staff). Current Ofsted guidance expects children's opinions to inform the review and report. CHH good practice: asking children is not the same as listening to them. A questionnaire that asks 'Are you happy?' and records 100% satisfaction is not genuine consultation.

Child-centred question

What would actually make this home better for you? What is the one thing you would change?

Vary the questions. Do not ask the same questions every review. Feed back to children what was heard and what changed as a result. If children see that their views lead to action, they are more likely to share honestly next time.

Parents and placing authorities

Regulation 45(5) refers to 'children, their parents, placing authorities and staff'. The Regulation does not itself add the qualification 'so far as is reasonably practicable and appropriate'. If statutory guidance adds practical qualifications or explanation about seeking parents' views, that is statutory guidance rather than the wording of Regulation 45. CHH good practice: not every child will have contact with parents, and not every parent's view will be appropriate to seek. The review should record what was done to seek views and what was heard.

Regulation 45(5) refers to 'placing authorities'. The legislation does not specify that the review must seek the views of the social worker or independent reviewing officer for each child. CHH practical guidance: seeking views through social workers, IROs or other professionals can be a useful way of ascertaining the placing authority's opinion. Their perspective on whether the home is meeting the child's needs can be important evidence. But this is practical guidance, not a statutory requirement to contact a particular professional for every child.

Staff views

Staff views matter too. Staff often know what is actually happening, but they need to feel safe to share concerns. A review that only gathers staff views through the management team is not hearing the full picture. Consider anonymous or confidential routes for staff to contribute.

Using evidence: what to look at

CHH practical guidance: the review should bring together evidence from multiple sources and triangulate it. No single source tells the whole story. A review that only looks at one type of evidence will miss things. Triangulation is a CHH method, not a statutory Regulation 45 requirement.

Regulation 44 reports

CHH practical guidance and current Ofsted guidance: Regulation 44 independent visitor reports are a key evidence source for the Regulation 45 review. Six months of Reg 44 reports saying the same thing is itself data. If the visitor has raised the same recommendation three times and nothing has changed, that is a finding for the Regulation 45 review. Regulation 45 itself does not explicitly state that Regulation 44 reports must be used, but current Ofsted guidance connects these quality assurance mechanisms.

Regulation 40 notifications

CHH practical guidance: Regulation 40 notifications tell you what serious incidents have occurred. But numbers alone tell very little. Three notifications in six months could be a sign of a problem, or it could be a sign that the home is identifying and reporting correctly. The review should look at the pattern, the type of incidents, and whether the response was appropriate. Regulation 45 itself does not require the use of Regulation 40 data, but current Ofsted guidance treats serious incident information as relevant evidence for the quality-of-care review.

Missing episodes

CHH practical guidance: missing episodes should be analysed. How many? What was the pattern? Were they from one child or several? What was the response? Were they preventable? A home that has no missing episodes may be doing well, or it may not have any children who are at risk of going missing. Context matters. Patterns in missing episodes are a relevant evidence source when evaluating the quality and impact of care.

Restraint and restrictive practice

CHH practical guidance: restraint data should be analysed. How often? Which children? Which staff? What were the antecedents? Is the frequency going up or down? Compare restraint with staffing: if restraint is high when agency staff are used, that is a finding.

Complaints

CHH practical guidance: complaints should be analysed. How many? What type? Were they resolved? A home with no complaints may be doing well, or it may be a home where children do not feel safe to complain. The review should look at whether the complaints system is accessible and whether children know how to use it.

Analysing outcomes for children

Current Ofsted SCCIF says the review should look at the quality of care, the experiences of children, and the impact of care on children's outcomes and improvements. This is current Ofsted guidance, not the exact wording of Regulation 45(2). CHH practical guidance: the review should look at outcomes for children, not just activity. Activity is what the home does. Outcomes are what happens to children as a result. A home that does a lot of activity but cannot show any improvement in outcomes may be busy but not effective.

Education

Are children attending school? Are they progressing? Are there barriers? A child who has missed a lot of school is a finding. A child who has started attending regularly after a period of absence is also a finding. The review should look at the trend, not just the current position.

Health

Are health needs being met? Are appointments being kept? Are there unmet needs? Unmet external need, such as waiting for CAMHS, is still management information. The home cannot control the waiting list, but it should know what is outstanding and be chasing it.

Positive relationships

Are children forming positive relationships? With staff? With peers? With family? A child who has gone from having no trusted adult to having a keyworker they trust is a positive outcome. A child who has become more isolated is a concern.

Enjoyment and achievement

Are children enjoying their lives? Are they achieving? This is harder to measure than attendance or health appointments, but it is central to the purpose of the home. The review should look at what children are doing, what they are interested in, and what they are proud of.

Care planning and placement endings

Are care plans being followed? Are placement endings planned and positive? The review should look at admissions and discharges. How many children were admitted? How many left? Why did they leave? Were the endings planned? Not every ending is a breakdown. Calling every ending a breakdown devalues the word and hides the real picture.

Staffing, turnover, training and supervision

Staffing is central to quality of care. The review should look at staffing levels, turnover, agency use, training and supervision.

Turnover

High turnover is a concern. It disrupts relationships, increases agency use and makes it harder to maintain consistent care. But staff retention can also be positive evidence. A home that keeps its staff, and where staff want to stay, is likely doing something right.

Agency use

Agency use should be analysed. How much? Which shifts? Is it reducing or increasing? High agency use can mean children do not know the staff looking after them, which affects relationships and safeguarding.

Training and supervision

Is training up to date? Is supervision happening? The review should look at whether training is being applied, not just whether it has been completed. Supervision that is happening on paper but not in practice is a finding.

Triangulation and analysis

CHH practical guidance: triangulation protects against one-sided conclusions. One complaint does not prove systemic failure. Equally, one positive Reg 44 report does not prove everything is good. The review should bring evidence together and look for patterns. Triangulation is a CHH method, not a statutory Regulation 45 requirement.

Starting points matter. A child who arrived with high needs and has made small progress may be doing better than a child who arrived with lower needs and has stayed the same. But do not use starting points to excuse stagnation. A child who has made no progress in two years is a concern, regardless of where they started.

The report and improvement actions

Regulation 45(3) requires the registered person to produce a written report about the quality of care review and the actions the registered person intends to take as a result. Current Ofsted guidance says a good report should summarise findings, contain analysis, identify strengths and weaknesses, include an action plan, focus on children's experiences and outcomes, and be honest and objective. These are Ofsted expectations, not the exact wording of Regulation 45(3). CHH good practice: the report should record what was reviewed, what was found, and what will change. It should be honest. A report that says everything is good and identifies no actions is either a perfect home or a review that was not done properly.

Current Ofsted guidance says the short report should include a plan setting out the action the registered person intends to take. CHH good practice: improvement actions should have owners and target dates. An action with no owner and no date is a wish, not a plan. Regulation 45 itself does not require named owners or target dates. The next review should check whether the actions were completed.

Multi-building homes

Current Ofsted SCCIF says that for a multi-building children's home, the manager should complete one Regulation 45 report covering every building in the registration. The manager may structure the report with separate sections for each building if useful. This is Ofsted's operational guidance. Regulation 45 itself places the statutory review and report duty on the registered person, not the manager.

How Ofsted uses Regulation 45 reports

Current Ofsted guidance says every Regulation 45 report is read by an inspector, usually the inspector allocated to the home. Reports help Ofsted assess whether leadership is reflective and open to learning. Reports help decide when to inspect and may shape what inspectors look at. This is current Ofsted guidance, not Regulation 45 legislation.

Using the Regulation 45 Tracker

The Hub's Regulation 45 Tracker helps providers organise the six-monthly review, distinguish core regulatory requirements from optional areas to explore, and track improvement actions. It does not prescribe the format of the review or the report.

Common mistakes to avoid

Key points